Paratyphoid Research Articles

Efektivitas Ekstrak Binahong (Andredera cordifolia steenis) Terhadap Salmonella typhi secara in Vitro

Binahong (Anredera cordifolia steenis) is one of the plants that has the potential to be developed as a raw material for antibiotic drugs. Typhoid fever is a systemic infection caused by Salmonella typhi (S. typhi). Salmonella paratyphi A, B, and C can also cause an infection called paratyphoid fever. Typhoid and paratyphoid fever are included in enteric fever. In endemic areas, about 90% of enteric fever is typhoid fever. This study is a true experimental in the Biology lab of Politeknik Medica Farma Husada Mataram using the well method with 5 treatments, the treatment was repeated 6x with various concentrations of 100%, 80%, 60%, 40%, and 20%, and cipropolacin antibiotics were used as positive controls and ethyl acetate as a negative control, the material used is thick extract of binahong leaves, after the thick extract of binahong leaves is produced, then the antibacterial inhibition test is carried out against the growth of salmonella thypi bacteria in vitro, the parameter observed is the diameter of the antibacterial inhibition zone of salmonella thypi, ANOVA test data analysis. The results showed that binahong leaves have the ability to inhibit the growth of salmonella thypi bacteria with the inhibition zone formed. The average inhibition zone of binahong leaf extract (Anredera Cardifolia Steenis) is 20% concentration of 18mm, 40% concentration of 12 mm, 60% concentration of 15mm, 80% concentration of 19 mm, and 100% concentration of 24mm.

Expert Group Opinion for Endemic Bacterial Infections in South Asia in Solid Organ Transplant Recipients - Typhoid, Paratyphoid, Leptospirosis, Scrub Typhus, and Melioidosis

Typhoid, paratyphoid, leptospirosis, scrub typhus, and melioidosis are some of the common bacterial infections which are endemic in the region of South Asia. Typhoid and paratyphoid cause enteric fever which is a common cause of fever in the general population in this region. It is caused by Salmonella through contaminated food and water. Enteric fever is one of the most common causes of fever in travelers in this region. Leptospirosis is a zoonotic disease caused by Leptospira and occurs due to direct contact with animals like or through abraded skin after the monsoon in the endemic area. Fever and jaundice are the most common presentations. Scrub typhus is caused by mite Orientia tsutsugamushi and it has now emerged as one of the most common causes of pyrexia in this region. Melioidosis is an uncommon infection caused by the bacteria Burkholderia pseudomalle, which is endemic in some regions of South Asia and is usually seen in immunocompromised individuals. Melioidosis is often called great mimicker due to a variety of clinical manifestations which might confuse it with other diseases. All these infections can cause fever or other systemic complications involving various organs in transplant recipients, so they should be kept as part of differential diagnosis of pyrexia in transplant recipients. There are no recommendations to screen for these infections in transplant candidates or donors, however, transplant candidates or donors with fever should be investigated for these infections and transplant should be deferred until full recovery and for some time thereafter.

Spread of water-borne Diseases in Pakistan

Water pollution can have an impact on us directly if we drink or bathe in a polluted stream, such as when we use municipal water, or indirectly if we consume vegetables that have been irrigated with contaminated water, fish, or other animals that live in or eat animals that have been raised in contaminated water. Drinking water contaminated with germs and chemicals is the primary cause of diarrhea. Contaminated water transmits infectious illnesses. Temperature, climate, topography, drainage, stream velocity, seepage properties of soil, safe drinking water supply, and adequate water disposal are all environmental factors that influence the prevention of water-borne diseases.
 Most common waterborne illness in Pakistan are cholera, dracunculiasis, typhoid and paratyphoid fever, hepatitis A& E, diarrhea, ulcers, dysentery, jaundice, amoebiasis and malaria.
 
 Around 2 - 2.5 million people die from diarrhea every year, and over 2.5 billion people lack access to modern sanitation systems (Fenwick, A. 2006). About 40% of deaths in Pakistan have been attributed to illnesses spread by polluted water (Akbar et al 2013). Access to safe water is a fundamental human right and a necessary prerequisite for health and development. Water-related illnesses brought on by inadequate access to clean water and poor sanitation and hygiene. Water that is contaminated and unclean is un-hygienic for living things, especially for human health. If not addressed quickly, it causes a number of grave health issues that can finally result in death.
 
 In Pakistan there is a need to improve the availability of clean water and sanitary facilities for both urban and rural populations, even in the most distant places. The ground water contaminated by various chemical components of industrial waste including arsenic, manganese, chlorine, and iron is very damaging. Surface drinking water is often polluted with E. coli, Enterobacter, Salmonella, and Clostridium, but lack of hygiene awareness is also a big factor in why people's health is suffering.
 
 In order to offer cleaner drinking water, the Pakistani government urgently needs to organize new waste water treatment facilities and restore old ones. Although reverse osmosis membranes are still in use today, it would be wiser to prepare for carbon nanotubes to take their place because they are less expensive and more effective. Additionally, there are three strategies to reduce the spread of waterborne infections in Pakistan and other developing nations: by increasing the amount and quality of drinking water; through better sewage disposal; and by providing access to affordable and suitable sanitation facilities

Antibiotic prescribing for acute gastroenteritis during ambulatory care visits-United States, 2006-2015.

To describe national antibiotic prescribing for acute gastroenteritis (AGE). Ambulatory care. We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006-2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen. We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%-15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%-36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%-26.4%), and penicillins (18.9%; 99% CI, 11.6%-26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%-12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%-13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%-71.9%), Campylobacter (44.8%; 95% CI, 41.5%-48.1%), Shigella (39.7%; 95% CI, 35.9%-43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%-38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%-33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%-13.0%) of visits for viral gastroenteritis. Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.

Recent Sensitivity Pattern of Salmonella Typhi in a tertiary care Hospital

Salmonella typhi is the main cause of the enteric fever in Homo sapiens. The topic of the concern now a day is the emerging multidrug resistance. It causes the disease of intestinal tract known as enteric fever, while Salmonella paratyphi cause the paratyphoid fever. This infection is waterborne and foodborne. Approximately 12 – 33 million people suffered from the typhoid fever annually around the globe. Objective: The aim of the study was to evaluate the sensitivity patterns of Salmonella typhi and Salmonella paratyphi. It is a retrospective study, conducted at the Medicine Department of Sahara Medical College, Narowal and Rawalpindi Medical University, Rawalpindi. Methods: The blood sample of 306 patients visiting the teaching hospital of our institute were collected. The samples were tested to evaluate the antimicrobial sensitivity. The Kirby-Bauer disc diffusion method was used. The E-test was leveraged for obtaining MIC of ciprofloxacin, while agar dilution method was utilized for obtaining MIC of azithromycin. Results: The samples were collected from patients. Out of the 306 sample, 177 samples were of S. paratyphi and other 127 were of S. typhi. 56% sample showed the sensitivity to ciprofloxacin antibiotic, while 281 samples showed sensitivity to nalidixic antibody. According to the MIC criteria 94% sample isolate were susceptible to ciprofloxacin and 46% to azithromycin. While 31% sample were resistant to it. 90% of the samples were susceptible to ampicillin while other 95% to trimoxazole. Conclusion: The co-trimoxazole and ampicillin care highly suggested for the management of the enteric fever. Ciprofloxacin resistance cannot be accurately measured by Nalidixic acid resistance screening. The samples also showcased emerging resistance against azithromycin.

Efficacy of Oral Azithromycin in Treatment of Uncomplicated Enteric Fever in Children

Background: Enteric fever also known as (typhoid or paratyphoid fever) is a common systemic infection with increased incidence of morbidity and mortality with salmonella typhi and paratyphi. Azithromycin has shown better outcomes in children with uncomplicated disease. Objective: To determine the efficacy of Azithromycin in treatment of uncomplicated enteric fever in children. Study Design: Descriptive case series study Place and Duration of Study: Department of Pediatrics, Sir Ganga Ram Hospital Lahore, Pakistan from 21st August 2015 to 20th February 2016. Methodology: One hundred and sixty five cases were included. Patients received capsule/suspension of Azithromycin (10 mg/kg/day) OD for 7 days. Treatment was labelled as effective if both clinical and microbiological cure were observed. Results: Patients ranged between 2-12 years of age. Mean age of the patients was 6.45±2.39 year. There were 85 males (51.5%) and 80 females (48.5%) in this study. Mean duration of fever was 6.97±1.37 days. Clinical cure, microbiological cure and efficacy was 93.9%. Conclusion: Azithromycin to be effective and safe in treatment of enteric fever. We observed high cure rate of 93.9% without any serious side effects leading to the conclusion that azithromycin is an effective oral agent for treatment for enteric fever. Keywords: Enteric Fever, Azithromycin, Salmonella Typhi/Paratyphi

Clinical manifestations and microbiological features between indigenous and imported enteric fever in Taiwan, 2010–2020

Previous studies had showed that indigenous clones of Salmonella Typhi and S. Paratyphi were originally imported from other countries in Taiwan. We presented the clinical manifestations and laboratory findings of indigenous and imported enteric fever cases in Taiwan in the current decade. We retrospectively reviewed typhoid and paratyphoid fever cases in two medical centers of Chang Gung Memorial Hospitals in 2010-2020. A total of 37 enteric fever cases including 24 typhoid fever and 13 paratyphoid fever were recorded. There were 20 indigenous cases, 16 imported cases, and one indetermined case. Splenomegaly and hepatitis were more frequent in typhoid fever than in paratyphoid fever (P<0.05). Imported cases had more ciprofloxacin non-susceptibility rate (8/16, 50.0%) than indigenous cases (2/20, 10%). Indigenous ciprofloxacin non-susceptible S. Typhi isolates were found in 2018. One indigenous S. Paratyphi B isolate was multi-drug resistant (MDR) to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole.

Paratyphoid Fever A: Infection and Prevention.

Enteric fever is caused by Salmonella enterica serovar Typhi, Salmonella enterica serovar Paratyphi A, B, and C. While S. Typhi remains the primary causative agent of enteric fever, S. Paratyphi A is responsible for an increasing portion of enteric fever incidence. However, the current available vaccines for enteric fever are all developed from S. Typhi, and lack adequate cross immune protection against paratyphoid fever A. Therefore, paratyphoid A vaccines are urgently needed. The present paper reviews the latest progresses in pathogenesis, global burden, infection features of paratyphoid fever A, as well as the status of vaccine development, highlighting the necessity for the development of vaccines against paratyphoid fever A.

Extensively Drug-Resistant Typhoidal Salmonellae: Are These Bugs Swarming Into Suburban and Rural Areas of Pakistan?

BackgroundTyphoid is a serious public health concern with increasing antibiotic resistance. Early suspicion and choice of susceptible antibiotics are key to avoiding the morbidity and mortality associated with this disease. We have carried out this study to assess the antibiotic sensitivity of typhoidal salmonellae in Kharian, Pakistan.Materials and methodsThis cross-sectional study was carried out at Combined Military Hospital, Kharian, Pakistan, from January 2019 to September 2020. Blood culture specimens from patients clinically suspected of enteric fever were tested through the BacT/ALERT 3D automated blood culture system. Positive microbial growth was further identified by colony morphology, appropriate staining, biochemical testing, and Salmonella-specific grouping sera. Salmonella typhi and Salmonella paratyphi A-C were further analyzed for antimicrobial susceptibility using agar disc diffusion testing by the modified Kirby-Bauer technique. The Clinical and Laboratory Standards Institute (CLSI) guidelines (2018-2020) document M-100 was followed for antibiotic selection and assigning the sensitivity status of the isolates. Meropenem and azithromycin were additionally tested keeping in view the possibility of encountering isolates with extensive antimicrobial resistance.ResultsA total of 315 blood culture samples were received during the study period. Of these, 239 (75.9%) reported negative and 76 (24.1%) were positive. The mean age was 22.37 ± 12.39 years. There were 41 (53.9%) males and 35 (46.1%) females. Salmonella enterica (combined Salmonella typhi and Salmonella paratyphi A) was 100% sensitive to azithromycin, meropenem, and imipenem. Ampicillin and chloramphenicol have 28.9% sensitivity each. Ceftriaxone, co-trimoxazole, and ciprofloxacin revealed 64.5%, 23.7%, and 11.8% sensitivity, respectively. Among them, 11.84% of the isolates were pan-sensitive, 35.5% of the cultures were multidrug-resistant (MDR), and 35.5% of the cultures were extensively drug-resistant (XDR).ConclusionThe study demonstrates that polyresistant typhoidal salmonellae are no more confined to a couple of outbreaks in large cities of Pakistan. It is the tip of the iceberg, and the balance has tilted toward difficult-to-treat typhoid and paratyphoid fevers all across the country owing to significant resistance to the commonly used antityphoid antibiotics (cephalosporins and fluoroquinolones). Azithromycin and carbapenems are offering the last line of defense against the rampant Salmonella typhi and Salmonella paratyphi.

Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project

SummaryBackgroundPrecise enteric fever disease burden data are needed to inform prevention and control measures, including the use of newly available typhoid vaccines. We established the Surveillance for Enteric Fever in Asia Project (SEAP) to inform these strategies.MethodsFrom September, 2016, to September, 2019, we conducted prospective clinical surveillance for Salmonella enterica serotype Typhi (S Typhi) and Paratyphi (S Paratyphi) A, B, and C at health facilities in predetermined catchment areas in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients eligible for inclusion were outpatients with 3 or more consecutive days of fever in the last 7 days; inpatients with suspected or confirmed enteric fever; patients with blood culture-confirmed enteric fever from the hospital laboratories not captured by inpatient or outpatient enrolment and cases from the laboratory network; and patients with non-traumatic ileal perforation under surgical care. We used a hybrid surveillance model, pairing facility-based blood culture surveillance with community surveys of health-care use. Blood cultures were performed for enrolled patients. We calculated overall and age-specific typhoid and paratyphoid incidence estimates for each study site. Adjusted estimates accounted for the sensitivity of blood culture, the proportion of eligible individuals who consented and provided blood, the probability of care-seeking at a study facility, and the influence of wealth and education on care-seeking. We additionally calculated incidence of hospitalisation due to typhoid and paratyphoid.FindingsA total of 34 747 patients were enrolled across 23 facilitates (six tertiary hospitals, surgical wards of two additional hospitals, and 15 laboratory network sites) during the study period. Of the 34 303 blood cultures performed on enrolled patients, 8705 (26%) were positive for typhoidal Salmonella. Adjusted incidence rates of enteric fever considered patients in the six tertiary hospitals. Adjusted incidence of S Typhi, expressed per 100 000 person-years, was 913 (95% CI 765–1095) in Dhaka. In Nepal, the adjusted typhoid incidence rates were 330 (230–480) in Kathmandu and 268 (202–362) in Kavrepalanchok. In Pakistan, the adjusted incidence rates per hospital site were 176 (144–216) and 103 (85–126). The adjusted incidence rates of paratyphoid (of which all included cases were due to S Paratyphi A) were 128 (107–154) in Bangladesh, 46 (34–62) and 81 (56–118) in the Nepal sites, and 23 (19–29) and 1 (1–1) in the Pakistan sites. Adjusted incidence of hospitalisation was high across sites, and overall, 2804 (32%) of 8705 patients with blood culture-confirmed enteric fever were hospitalised.InterpretationAcross diverse communities in three south Asian countries, adjusted incidence exceeded the threshold for “high burden” of enteric fever (100 per 100 000 person-years). Incidence was highest among children, although age patterns differed across sites. The substantial disease burden identified highlights the need for control measures, including improvements to water and sanitation infrastructure and the implementation of typhoid vaccines.FundingBill & Melinda Gates Foundation.

Fever in the Returning Traveler.

It is predicted that approximately two billion tourist trips to foreign countries will be taken worldwide each year by 2030. Germany has long been among the most active countries in tourism. The frequency of illness among persons returning from developing and newly industrialized countries is 43-79%. The appropriate diagnosis of fever in returning travelers is a clinically important matter, as it can be a sign of a life-threatening illness. This review is based on publications (2001-2022) retrieved by a selective search in PubMed for studies on the epidemiology, diagnosis, and treatment of febrile illnesses in returning travelers, or on specific tropical diseases. Diarrhea, fever, and skin changes are the most common manifestations of disease after travel to tropical and sub - tropical areas. The diagnostic evaluation should be performed in a series of steps, beginning with a precise travel history and the identification of specific risk factors. Among travelers returning from sub-Saharan Africa, Plasmodium falciparum malaria is the most common cause of fever on presentation to centers for infectious diseases and tropical medicine, affecting approximately 50 per 1000 travelers. Among persons returning from travel to Southeast Asia, dengue fever is the most common infectious disease, affecting 50-160 per 1000 travelers. Further potentially dangerous diseases include chikungunya and zika fever, typhoid and paratyphoid fever, amoebic liver abscess, visceral leishmaniasis (kala-azar), leptospirosis, and, very rarely, imported cases of viral hemorrhagic fever. COVID-19 and influenza are important differential diagnoses. The differential diagnosis can be narrowed by thorough history-taking with particular attention to the patient's travel route, combined with a good knowledge of the geographic spread and incubation times of the main tropical diseases. Algorithms help clinicians to focus the diagnostic work-up and select the appropriate further laboratory tests and diagnostic procedures.

Antisalmonellal Activity and GC-MS Analysis of Piliostigma thonningii leaf extract

Background: Typhoid fever is a serious bacterial infection which causes bacteremia and inflammatory destruction of the intestine and some internal organs in the body. The widespread emergence of multi-drug resistant Salmonella typhi and Salmonella paratyphi has necessitated the search for other therapeutic options. The study was conducted to screen the antisalmonellal activity of Piliostigma thonningii leaf crude extract, fractions and isolated compounds. Methods: The plant leaves were extracted with 70% methanol, the crude extract was partitioned into fractions and was tested for antibacterial activity against S. typhi, S. paratyphi A, S. paratyphi B and Salmonella paratyphi C using agar well diffusion technique. Column and thin layer chromatographic methods were used for phyto-constituent separation of plant extract. The most effective antisalmonellal column chromatography isolated compound was subjected to Gas Chromatography-Mass Spectrometry (GC-MS) analysis. Results: The crude extract and the fractions except n-hexane fraction possess antibacterial activity on at least one of the Salmonella strains tested, however, the ethyl acetate fraction (PT1-03) exhibited the widest zone of inhibition on the test bacteria (14-16 mm) at the concentration of 100 mg/ml. The zones of growth inhibition increased with the increasing concentration of the fractions. The corresponding increase in concentration and growth inhibition zone was significant (p&lt;0.05). The isolated compound obtained from the column chromatography also showed significant inhibition on the Salmonella strains (12-15 mm) at the concentration of 50 mg/ml. GC-MS analysis of the column chromatography isolates revealed Levomenthol and hexadecanoic acids as the major compounds. Conclusion: The study clearly indicates that P. thonningii possesses bioactive compounds that are active against some Salmonella species. Therefore, these phytochemicals can be formulated into drugs for the treatment of typhoid and paratyphoid fevers

Genomic surveillance reveals international circulation and local transmission of Salmonella enterica serovars Typhi and Paratyphi A in Taiwan.

Morbidity and mortality from typhoid and paratyphoid fever remain an important problem for public health authorities in developing countries. In countries with lower incidences, most cases occur in travelers who visit regions in which typhoid and paratyphoid fever are highly endemic. The aim was to evaluate the source and transmission dynamics of typhoid and paratyphoid fever in Taiwan by using genomic analysis. During 2012-2019, 15 clinical isolates of Salmonella Typhi and S. Paratyphi A were collected. Demographic and clinical information of the infections were analyzed. We performed whole genome sequencing and evolutionary analysis on these isolates. Clinical and microbiological data from 7S. Typhi and 8S. Paratyphi A isolates in Taiwan showed epidemiological and bacterial genomic link to the infection in South and Southeast Asia. The Taiwanese typhoidal isolates also share highly similar genomes with those collected from UK, indicating global circulation of the typhoidal clones. Local transmission of the imported but indigenized international clones was observed. Mutations occurring at gyrA 83 aa, including S83Y and S83F, were identified in the ciprofloxacin-resistant strains. Due to the advance of global transportation and communication, the transmission mode of infectious disease has been modified. Domestic typhoid and paratyphoid fever caused by international resistant clones can occur in low-incidence countries. Genome analysis showed that the indigenous clone originally imported from other countries has been circulating in Taiwan for over a decade.

Hematology Parameter Based on Tubex TF® Color Scale Result in Typhoid Fever Patients

BACKGROUND: Infection with Salmonella enterica subspecies serovar Typhi and Paratyphi A, B, and C causes typhoid and paratyphoid fever. This is a major source of mortality and morbidity, especially in youngsters. Typhoid fever frequently causes non-specific symptoms. Symptoms that appear obstructively are comparable to those seen in other infectious illnesses and have similar clinical manifestations. Complications can be avoided with early detection and treatment. AIM: This study will look at the hematology parameter profile to determine whether there are any hematological differences between patients with high and low antibodies. METHODS: The research was conducted in Bengkulu, Indonesia, in June 2020 until July 2021. Subject collection was done according to inclusion and exclusion criteria. Subjects have given informed consent. The research included a total of 39 subject patients. Demographic data were collected using a questionnaire and 3 mL of blood was taken. Blood was examined for Tubex TF® and hematological examination. Statistical analysis used independent t-test and performed with SPSS. RESULTS: The research included a total of 39 subject patients. Most were male and most were aged 21–25 years. The most common symptom felt by the subject was gastrointestinal complaints. The analysis was carried out based on the color scale value of the Tubex TF® which was divided into two groups, 4 color scale groups and 6 color scale groups. Hematological parameters of hemoglobin, hematocrit, WBC, platelets, monocytes, lymphocytes, and neutrophils showed no significant difference. However, color scale group 6 showed lower value than 4 color scale group. CONCLUSION: Hematological indicators in typhoid fever were not substantially changed in Tubex TF®-positive typhoid fever patients. Clinicians can offer the same therapy in instances with typhoid fever, despite having differing positive Tubex TF® scores.

Towards equitable scheduling of global health teleconferences: a spatial exploration of the world’s population and health by time zone

ObjectivesTo examine the world’s population, development, and health by condensed Coordinated Universal Time (UTC) offset to support a normative position on how to most defensibly schedule global health teleconferences with...

Impact of Temperature and Rainfall on Typhoid/Paratyphoid Fever in Taizhou, China: Effect Estimation and Vulnerable Group Identification.

The impact of temperature and rainfall on the occurrence of typhoid/paratyphoid fever are not fully understood. This study aimed to characterize the effect of daily ambient temperature and total rainfall on the incidence of typhoid/paratyphoid in a sub-tropical climate city of China and to identify the vulnerable groups for disease prevention. Daily notified typhoid/paratyphoid fever cases and meteorological data for Taizhou from 2005 to 2013 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. Distributed lag nonlinear model was used to quantify the association between daily mean temperature, total rainfall, and typhoid/paratyphoid fever. Subgroup analyses by gender, age, and occupation were conducted to identify the vulnerable groups. A total of 625 typhoid fever cases and 1,353 paratyphoid fever cases were reported during the study period. An increased risk of typhoid fever was detected with the increase of temperature (Each 2°C rise resulted in 6%, 95% [confidence interval] CI: 2-10% increase in typhoid cases), while the increased risk was associated with the higher temperature for paratyphoid (the highest cumulative risk of temperature was 33.40 [95% CI: 12.23-91.19] at 33°C). After the onset of mild precipitation, the relative risk of typhoid fever increased in a short-lasting and with a 13-26 days delay, and the risk was no significant after the continuous increase of precipitation (the highest cumulative risk of rainfall was 24.96 [95% CI: 4.54-87.21] at 100 mm). Whereas the risk of paratyphoid fever was immediate and long lasting, and increase rapidly with the increase of rainfall (each 100 mm increase was associated with 26% increase in paratyphoid fever cases). Significant temperature-typhoid/paratyphoid fever and rainfall-typhoid/paratyphoid fever associations were found in both genders and those aged 0-4 years old, 15-60 years old, farmers, and children. Characterized with a lagged, nonlinear, and cumulative effect, high temperature and rainfall could increase the risk of typhoid/paratyphoid fever in regions with a subtropical climate. Public health interventions such as early warning and community health education should be taken to prevent the increased risk of typhoid/paratyphoid fever, especially for the vulnerable groups.

Enteric Fever Pattern among Patients Attending General Hospital Kaltungo

Salmonella typhi and Salmonella paratyphi causes typhoid and paratyphoid fevers respectively. Out of the one thousand two hundred and six (1206) sample analyzed for Typhoid and Paratyphoid fevers using tile method; 748 (62.0%) were positive while 458 (38%) were negative. Females were found to have the highest positivity rate of 413 (68.4%), while males had 335 (55.5%) positivity rate. The age bracket with the highest positivity rate 0-10years and above (28.3%), followed by 11-20years (26.2%). The age bracket with the lowest percentage positivity was 60years and above (6.0). We therefore wish to conclude that women should take personal hygiene serious and people from the following age groups of 0-10years and those at age 11-20 regardless of their sex should do likewise as Salmonellosis was found to be high among those categories of people.

Physicochemical, Bacteriological and Parasitological Quality of Water Used to Wash Vegetables in Dschang, West Cameroon: Health Risk Assessment

The quality of water used for the cleaning fresh vegetables sold in Cameroonian cities is of little concern. The objective of this study was to determine the health risk associated with the water use for washing fruits and vegetables in the city of Dschang, in order to help develop strategies for the control waterborne diseases in Cameroon in general and in Dschang in particular. After a survey of 75 vegetable vendors in the Dschang market, 40 samples of washing water, 20 per season, were collected randomly throughout the main market in the city of Dschang. Physicochemical, bacteriological and parasitological analyses were carried out according to standard methods. Regardless of the season, bacteria indicative of faecal contamination were detected in the water used for washing fresh vegetables, with levels ranging from 0 to 8×10⁴ CFU/100ml for <i>Escherichia. coli</i>, from 1.8×10⁴ to 1.8×10⁸ CFU/100ml for faecal coliforms, from 3×10⁴ to 7.2×10⁸ CFU/100ml for <i>Salmonella</i> spp., from 30 to 1.3×10⁷ CFU/100ml for <i>Shigella</i> spp. and 20 to 7.5×10⁵ CFU/100ml for faecal streptococci. <i>Ascaris</i> spp. eggs, <i>Entamoeba</i> spp. cysts and nematode larvae were detected in vegetable washing water, with a prevalence of 40%. Consumers of fresh vegetables washing by these waters, if raw and poorly washed, are at risk of bloody diarrhoea, gastroenteritis, typhoid and paratyphoid fever or inflammation of the colon tissue and severe necrosis. The authorities should introduce food hygiene in the markets as part of the strategies to combat waterborne diseases in this city. This solution is also valid for other cities in Cameroun.

Variable Presentations of Enteric Fever, beyond Fever and Pain Abdomen: A Case Series

Enteric Fever (Typhoid and Paratyphoid fever) is an illness that presents with marked pyrexia, abdominal pain and other gastrointestinal symptoms. Symptoms and complications primarily involve gut. But sometimes it involves other organ systems like heart, and brain. It thus poses a great diagnostic challenge in diagnosing these extraintestinal manifestations. The three cases depicted in this case series had unusual presentations in the form of dilated cardiomyopathy, non haemophagocytic lymphohistiocytosis (HLH) dyslipidaemia and encephalopathy. The first case is a case of reversible cardiomyopathy in a 26-year-old male presenting with fever for seven days with headache, loose motions and vomiting with audible S3 and bibasal crepitations without oedema. The patient responded to ceftriaxone and azithromycin. On echocardiography dilated cardiomyopathy was diagnosed after which treatment with ramipril and metoprolol was started. The second case was of a 30-year-old female presenting with fever, vomiting, and abdominal pain. There was hypertriglyceridaemia with normal ferritin levels. The patient responded to ceftriaxone. High Density Lipoprotein (HDL) level was low. Statin and fenofibrates were added after which the triglyceride levels came down. This was an interesting case of nonHLH dyslipidaemia which responded to therapy. The third case was of a 40-year-old female presenting with fever for six days with impairment of consciousness. Bilateral plantar responses were extensor and there was no papilledema or any cranial nerve palsy. Magnetic Resonance Imaging (MRI) Brain and Cerebrospinal Fluid (CSF) study were normal. The patient responded to ceftriaxone and dexamethasone proving beneficial effects of steroids in enteric encephalopathy. The purpose of the case series was to make clinicians aware of these uncommon presentations of a common disease so that early diagnosis and treatment with Anti Salmonella antibiotics can be initiated quickly to prevent complications.

Paratyphi PneumoniaDoes What You Eat Matter?

Most common signs and symptoms of typhoid are localised to gastrointestinal system. Less commonly, extraintestinal infectious complications occur with enteric fever. This case report is about a 29-year-old female, without risk factors, who presented with fever, loose stools and cough of five days duration. The patient was diagnosed to have paratyphi A bacteraemia, with clinical and radiological features of pneumonia. Her sputum cultures were sterile, and hence paratyphi A pneumonia was diagnosed. She received 14 days of antimicrobial therapy and recovered. Vi-based monovalent vaccines do not offer protection against most paratyphoid fever, because only Salmonella serovars Typhi, and paratyphi C carry the Vi antigen. Further studies are needed on bivalent and polyvalent typhoid vaccines covering all serovars.